Critical Analysis Nursing Care for the Older Adult

Critical digest Nursing C argon for the Older Adult craziness is an umbrella marches to describe a collection of symptoms that develop in association with a progressive rowdiness of the brain of which monomania of the Alzheimers type is the most common. other(a) forms of dementia include Lewy body dementia, Picks disease and (MID) multi-infarct dementia (Ramsay et al, 2005). The main features of dementia ar a set in entrepot, ability to learn and project in a continuing progression. There are often changes in affable behaviour, general motivation and the lymph nodes ability to control their own emotions (Burgess, 2005). These changes change from a gradual to more sudden onset that varies from individual to individual. In the early st climb ons of dementia memory problems are often the most unequivocal sign (DH, 2009).Mental wellness practiti unmatchedrs find that memory problems and other necessarily are plainly the beginning of the process in making a diagnosis. The come to is required to check in what ways an individual is non functioning as they would expect. Assessments may be carried out at stem in order to gain a clearer image of how the thickening is managing (Ramsay et al, 2005). The doctor leave also expect to know the leaf nodes medical history including whatsoever physiologic illness and current medication. The doctor will also ask to rule out depression as a do of the memory problems. If the memory problems are attri thoed to depression, then intercession using an antidepressant could attention substanti all in ally (Ramsay et al, 2005). Diagnosis is a scientific tool. Beyond that the cathexisr requires an understanding of the knobs ca intention of having a problem or disorder, wellness and social wangle inescapably to be values found as well as consequence based. To translate this philosophy into place requires that the sagacity process be operate by the principles of mapnership, holism and nighbodyalisatio n (Atkins et al, 2004). Assessment is a valid and integral part of any treat intervention and must(prenominal) be performed in confederation with the thickening (RCN, 2004).Following this, the next step is to consider involvement of conglomerate investigations, often carried out in hospital or in a clinic, including the use of blood testing, X-ray and if necessary, brain scanning to discover the cause of the symptoms (Ramsay et al, 2005).To carry out a full assessment of the clients problems, other practiti cardinalrs are likely to play a part in the assessment as part of a multi-disciplinary team (MDT). Members of the team may include concurs, occupational therapists, psychologists, physiotherapists, social workers and doctors. Making a diagnosis is definitive as diagnosis affects the type of treatment used (Ramsay et al, 2005)Difficulties that can occur in perform when attempting to engage with clients in an effective manner include making all of the information that is e xistence exchanged comprehensible to the client, finding methods to narrow frequency of forgetting that can occur, finding methods to encourage clients to feedback information positive or negatively charged to overcome any punishingies that many bulk can feel in clinical settings (Ley, 1997).The reflective account outlines the vastness of communication skills in practice where the prevail can be delivering caution to individuals with very specific needs that must be attended to with privacy, shelter and dignity for the health and upbeat of the patient. In the account it is clear that clients with dementia can find communication, mobility, and physical health problems difficult and in managing the apportion of clients with dementia although challenging, may be overcome by dint of empathic understanding and best practice including distinguish based treat delivery. In relation to communication, the most suitable advance is the use of selective questioning, providing information, respecting psycheal dignity and being clear so that the client understands (Zimmermann, 1998).Patient centred methods of dread place demands on hold ins because much(prenominal) a method involves responding to the cues from clients in which feelings and emotions are expressed. Nurses are required to develop the expertness to respond in an appropriate manner to the clients feelings and emotions (Stewart et al, 1989). In order to go away high fiber person centred care, the needs of to distri stillively one patient must be assessed individually to ascertain plusal requirements that the client may waste. Conversely, slightly clients will require less assistant than initially considered by the team. It is as definitive to understand these needs in order to respect each clients need for independence (Stewart et al, 1989). Best care can be delineate by the underlying principles that communication should always be person centred (Oberg, 2003). indeed the client should be earmarkd with a theatrical part standard of care that allows a sense of control over the treatment that is being provided. It is vital that the client is involved in their own care and treatment, not only does this assign the comfort and dignity of the person, but prevents errors and miscommunication leading to an effective client/ cling to relationship. In one study findings concluded that actively involving the patient in aspects of care and treatment often leads to earlier recovery and an improved quality of life (Stewart et al, 1989).Overview of compassionate Practice Reflection in ActionIn practice, a male client was confused as a emergence of his dementia. The client was an older adult who used a wheelchair and required assistance with mobility because of a leg amputation. Sometimes the client would try to leave his wheelchair which resulted in him falling to the floor. The client was unable to find the lavatory and was becoming more and more frustrated by h is inability to identify specific places. In addition the client became agitated and at times had difficulty with peaching. On one occasion the client called a value who responded to the patient, approaching him slowly from the appear and greeted him, and asked How can I help? Is everything ok? The patient responded to the question with an set I need I need to go to the The client repeat this statement several times with increasing sense of urgency but was unable to find the correct word to finish the sentence ascribable to his level of confusion. The client experienced memory problems and episodes of agitation. Managing the clients ability to be spotless was another important consideration in the care of the individual as he used an attachment (catheter) and was occasionally incontinent of faeces (Johns, 2000 Schn, 1983 1987).The assessment phase of the treat process is funda psychical at this stage of the interaction so that the nurse was able to ascertain if the client r equired the use of the toilet (Kozier, 2004). The nurse asked the client if he needed to use the toilet. The client responded by nodding his head and saying yes. The visualisening phase of the nursing process is equally important at this stage. The nurse informed the client that he would show him the way and escorted the client to the toilet. When speaking to the client the nurse was careful to maintain eye-contact and speak slowly and calmly to ensure that the client would understand. Whilst being escorted the client explained that he had been incontinent of faeces. The client began apologising but the nurse reassured him and explained that he would get him some fresh clothes (Johns, 2000 Schn, 1983 1987).The nurse was able to provide comfort and maintain the dignity of the client as well as the clients confidence in the nurses abilities. The client was reassured and an chronicle of the outgrowth was provided to the person in a step-by-step process, asked if he dumb and if he wa s agreeable. The client confirmed he was agreeable and began to converse with the nurse and appeared much more relaxed. The client responded with additional banter and appeared more content. The client was able to carry out more intimate aspects of his personal cleanse so that further consideration to preserving his dignity and independence was maximised. The nurse recommended that the clients catheter traction was emptied on a more regular basis to aid comfort and reduce distress (Johns, 2000 Schn, 1983 1987). The NMC (2008) guidelines stipulate that nurses maintain the respect, dignity and comfort of clients. aft(prenominal) being washed the client was assisted with putting on clothing, explaining each step slowly, the client responded y following each step and no longer appeared agitated and was returned to the lounge in a wheelchair. The student inform the information to the rest of the team and discussed regular catheter care for the client.Reflection on ActionDuring the re flection in action (Johns, 2000 Schn, 1983 1987) the nurse was able to right away and in effect clean and change the client with comfort and dignity through implementation of the nursing process and incorporating the ideas of assessment, diagnosis and planning phases of care. The reflection on action (Schn, 1983 1987) highlights what the nurse was trying to achieve and provides opportunity to consider alternatives for time to come practice. Care was delivered to the client using the Care Programme Approach (certified public accountant) and the procedure utilise to offer a framework to complement policy documents and because allow the process to be followed. The approach allows mental health practitioners to provide a structured pattern of care throughout the process, assess clients need, plan ways to rival the needs and check that the needs are being met (DH, 2007).Those who experience dementia may find some tasks increasingly difficult such as everyday tasks of living, includin g washing and dressing without assistance or with finding the right words when talking. Interaction for the person can commence increasingly difficult and distressing for the client in their relationship with others (Ramsay et al, 2005). Dementia care practice provides opportunities to mental health nurses on how to engage efficaciously with clients.During the initial contact stages of any nurse and client interaction it is important that the nurse keeps the environment simplified and to eliminate noise that can disorder the client (Zimmermann, 1998). It is useful if the nursing team minimises activity occurring in a shift change because a confused client may misunderstand nurses saying goodbye to each another and may wish to leave. near the client slowly and making eye contact can reduce any pretend of alarming the client (Zimmermann, 1998). Also the nurse should speak slowly and calmly with pauses so that the client responds to the content of the communication and not the ma nnerisms of the nurse (Zimmermann, 1998). These skills may help to reduce the clients anxiety and confusion.The National portion Framework (NSF) for older heap sets out subject standards and service models of health/social care that older people using mental health services can expect to receive, whether they are living at home, in care or are in hospital (DH, 2001 WAG, 2006). Older people are generally referred to as anyone aged sixty and over and the national ten year initiative is to ensure better health and social care services for people meeting the criteria. It includes older people with dementia, carers and ethnic minority groups. In addition, age discrimination and patient-centred care have been place as two key areas. Including the NSF, there have been a add of campaigns to promote dignity in the care of older people, recognising that standards of care in some cases are poor and inadequate (DH, 2006a).Unfortunately, there has been a overlook of clarity associated wit h the notion of dignity and the appropriate minimum standards and/or recommendations that should be applied. For example, in an attempt to address the concerns of dignity the Department of health published an online public cartoon rough the views of dignity and care provision (DH, 2006a). Results of the survey reported that a many aspects of care were identified by older people as vital in maintaining dignity, such as respecting the person and communicating effectively.The Lets Make It Happen NSF (2002) outlines eight standards of care that address issues such as age discrimination, person centred care, mental health and the promotion of health and active life in old age. The success of the NSF for Older sight depends on how well it is being implemented. Lets Make It Happen follows the NSF for Older batch in 2001 and centeringes on examples of research and good practice through evidence based care provision, which demonstrates how implementing good practice can improve people s quality of life and should also help to develop ideas for how the NSF might be implemented (Alzheimers Society, 2002).In 2006, the Department of Health released a report A new-sprung(prenominal) Ambition for Old Age, in an attempt to move the requirements outlined in the National Service Framework forward, and offers details of the next stage of health care reforms for older people. This documentation places older peoples needs as integral to care planning and delivery, with respect and the maintenance of dignity by recognising the existing issues around health related age discrimination (Department of Health 2006b). Furthermore, the Department of Health have established a set of benchmarking tools to root out age discrimination and to advance person-centred care (Department of Health 2007a). This is to be achieved, in the basic place, by actively listening to the views of users and carers about the services they need and privation (Department of Health 2007a).Within Wales the Care Programme Approach (certified public accountant) is highly regarded as the cornerstone of the Governments mental health policy and procedures. The framework was introduced in 2004 for the care of people with mental health issues who are accepted as clients by mental health services in an inpatient or connection setting. All NHS Trusts in Wales participated in a review and all had processes in place to deliver CPA to clients (Elias Singer, 2009). Although the review sample was small, findings were consistent across all the organisations, and demonstrated that CPA had not been implemented as effectively as it should. If this randomly selected sample is representative of all mental health services in Wales, there is a risk that services are failing clients and carers due to a lack of adequate risk way processes, a lack of focus on the outcome of patient interventions, and a lack of service planning and service models to safely and adequately meet clients needs. Greater focus i s needed on the assessment and management of risk (Elias Singer, 2009).Practitioners must be prepared and fully trained to fulfil the role of care co-ordinator. Information systems need to meet client needs sort of than organisational priorities. The current system is very complex and bureaucratic particularly where CPA and the Unified Assessment (UA) have been integrated into a single process. A record management system needs to be developed that supports CPA and UA whilst also providing the least administrative burden for clinicians and practitioners (Elias Singer, 2009).A significant core of evidence exists suggesting that providing care for a person with dementia is not only stressful, but can also have a negative blow on the carers mental health (Cooper et al, 1995). Recently, government policy has expressed the importance of offering support to carers. This has been highlighted by the Audit Commission report examining mental health services for older people (2000).Researc h suggests that carers needs are multifaceted, and that support is needed at times of transition, for example diagnosis, admission of the person they are caring for to residential care and the death of the person with dementia. (Aneshensel et al, 1995). The need for more advanced gentility in the field of dementia care has been recognised for quite some time (Keady et al, 2003). NICE and the Social Care Institute for Excellence (SCIE) recently developed guidelines for supporting people with dementia and their carers (NICE SCIE, 2007). The guidelines identified the main remedy interventions and when and why they should be used. The principal focus of care should involve maximise nonsymbiotic living skills and enhancing client function. This will involve assisting clients to adapt and develop their skills to minimise the need for support (NICE SCIE, 2007).This should develop in the early stages of the condition, and could involve a number of services and the clients carers. Pro viding care in ways that promote independence is liable to take time, but it is the core intervention for people with dementia on a therapeutic basis. The NICE and SCIE (2006) guideline identified key interventions that should be utilized for maximising function. Care plans are vitally important and should include the activities that are important for maintaining independence. Care plans should take account of the individuals type of dementia, their needs, interests, preferences and life histories (NICE SCIE, 2006). Obtaining advice about clients independent toilet skills is important. If the client experiences episodes of in self-control, any realistic causes should be assessed and then treatment options tried before the team concludes that incontinence is permanent. Physical exercise should be encouraged when possible and facilitated in a safe environment, with assessment advice from a physiotherapist when required. As exercise is thought to help improve continence problems, los s of mobility and improve endurance, physical strength and balance in travel prevention (NICE, 2004) physical exercise should be promoted by all staff. healing(predicate) interventions for the cognitive symptoms of dementia are comprised of psychological and pharmacological treatments. However, providing supportive levels of care that encourage clients to maintain as much of their independent functions as possible is equally as important as any specific interventions for the cognitive symptoms of dementia (NICE, 2007 Moniz-Cook Manthorpe, 2009).Much has been written about medical and social models of dementia, some of which has implied that there are a number of different ways of looking for at dementia, one as a disease model and one as a disability. Some of these differences are described in tom Kitwoods Dementia Reconsidered (Kitwood, 1999). Kitwood described the medical model as the standard paradigm, and argues articulately that it is the wrong model to use. Dementia is an illness that causes a progressive decline in cognitive abilities and there are demonstrable changes to the brain. It is, however very important to remember that we are treating a person with dementia. How the condition presents depends on the clients personality, their relationships with others, and who they are as a person (Kitwood, 1999).Nurses and GPs have cited inadequate schoolmaster training as one of the main factors influencing their ability to provide an optimal service to people with dementia (Iliffe Drennan, 2001 Alzheimers Society, 1995). However, it is not known what method of training would equip them with the right range of knowledge and skills. Around 700,000 people in the UK have dementia, and this number is predicted to double to 1.4 million over the next 30 years (DH, 2009).ConclusionIn summary, dementia is a debilitating disorder that is having a massive impact on mental health services. The launching of numerous frameworks for the care of the older adult and other policy documents have set the standards expected of mental health professionals and backs up evidence based care with a high standard of principals and values (RCN, 2004 DH, 2009,). The number of people being diagnosed with a dementia is increasing, and although difficult to manage, through continued research, growing and training of staff and practicing with empathy, treating clients with dignity and respect and upholding the core values of the nursing profession (NMC, 2008) dementia care services and service providers may reach the potential difficulties that lay ahead. In these uncertain times it is comforting that the care of the older adult has not been forgotten.